Table 3 Personalized recommendations given to the Nutrigenetic test patient group in addition to base diet.

Variation in MTHFR, MTRR, MTR or CBS:

Rationale: Polymorphisms in genes involved in folic acid metabolism have been shown to influence this pathway affecting plasma homocysteine levels as well as the balance between DNA methylation and synthesis of nucleotides [14, 15].

Recommendation: Add supplement containing 800 mcg folic acid, 15 mg Vitamin B6 and 20 mcg B12

Variation in GSTM1, GSTT1 or GSTP1:

Rationale: Patients with deletions in GSTM1 which affect Phase II detoxification processes have been shown to have reduced levels of DNA adducts [16], and increased levels of GSTA1 circulating activity [17], when adequate levels of cruciferous vegetables have been consumed. Risk for lung cancer drops by up to 80% in individuals lacking GSTM1 and/or GSTT1 genes when consumption of cruciferous vegetables is high [18].

Recommendation: Ensure diet includes regular portions of cruciferous (5 times per week) and allium (daily) vegetables (suggestions and recipes provided to patient). Add broccoli extract and allium supplement if required.

Variation in SOD2, SOD3, NOS3:

Rationale: superoxide dismutase enzymes are free radical scavengers that have important antioxidant activity which can be affected by genetic polymorphism [19]

Recommendation: Add supplements containing antioxidants, Vit A (5,000 IU), Vit C (250 mg) and Vit E (200 IU).

Variation in VDR, COL1A1:

Rationale: Several studies have shown that gene-diet interactions have a role to play in maintenance of bone condition. For example caffeine increased rate of bone loss but only in the presence of the VDR taq1 variant [20]. Others have shown gene-diet effects involving calcium [21, 22] and vitamin D [23].

Recommendation: Keep caffeine below 2 cups coffee/day. Increase dairy component of diet (yoghurt, cheese and low fat milk). If required add supplement containing 800 IU vitamin D and 1,300 mg Calcium

Variation in TNFα, IL6, NOS3:

Rationale: Variations in inflammation pathway genes TNFα and IL6 have been shown to be pro-inflammatory and the effect can be modulated by increased levels of fish oil in the diet [24]

Recommendation: Add supplement Omega 3 (700 – 1,400 mg). Make sure weekly diet contains portions of oily fish

Variation in CETP, LPL, APOC3:

Rationale: Polymorphisms in genes involved in lipid metabolism and transport, in combination with dietary fat intake, have been shown to affect plasma cholesterol levels [25]

Recommendation: The base low fat is already within the limits recommended for these variations so no further specific advice is given but current advice is reinforced and advice given to restrict consumption of dairy foods.

Variation in ACE, PPARG:

Rationale: gene-diet and gene-exercise interactions have been reported to affect blood glucose and insulin levels [26, 27]

Recommendation: The base low glycemic diet is already within the limits recommended for these variations so no further specific advice is given but current advice is reinforced. Extra exercise advised for this group